Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review

Question: What is the inter-rater reliability for measurements of passive physiological or accessory movements in lower extremity joints? Design: Systematic review of studies of inter-rater reliability. Participants: Individuals with and without lower extremity disorders. Outcome measures: Range of motion and end-feel using methods feasible in daily practice. Results: 17 studies were included of which 5 demonstrated acceptable inter-rater reliability. Reliability of measurements of physiological range of motion ranged from Kappa -0.02 for measuring knee extension using a goniometer to ICC 0.97 for measuring knee flexion using vision. Measuring range of knee flexion consistently yielded acceptable reliability using either vision or instruments. Measurements of end-feel were unreliable for all hip and knee movements. Two studies satisfied all criteria for internal validity while reporting acceptable reliability for measuring physiological range of knee flexion and extension. Overall, however, methodological quality of included studies was poor. Conclusion: Inter-rater reliability of measurement of passive movements in lower extremity joints is generally low. We provide specific recommendations for the conduct and reporting of future research. Awaiting new evidence, clinicians should be cautious when relying on results from measurements of passive movements in joints for making decisions about patients with lower extremity disorders. [van Trijffel E, van de Pol RJ, Oostendorp RAB, Lucas C (2010) Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review. Journal of Physiotherapy 56: 223-235]